Pediatrics Final Exam |100 Questions and Answers
The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency anemia.
Which finding indicates that the infant is not tolerating activity?
1. Heart rate of 138
2. Increased alertness
3. Respiratory rate less than 40 with activity
4. Muscle weakness - -Answer: 4
Explanation: Iron deficiency anemia can result in less oxygen reaching the cells and tissues,
causing activity intolerance. An indication that a 9-month-old child is not tolerating activity
and that iron deficiency anemia is worsening would be the presence of muscle weakness
during activity. A heart rate of 138, increased alertness, and a respiratory rate of less than
40 with activity are all signs that iron deficiency anemia is resolving and activity tolerance
is improving.
Page Ref: 592
-Which action by the parents demonstrates an understanding of the nurse's teaching with
regard to prevention of iron-deficient anemia?
1. Feeding their infant with a formula that is not iron fortified
2. Starting iron-fortified infant cereal at 4 to 6 months of age
3. Introducing cow's milk at 6 months of age
4. Limiting vitamin C consumption after 1 year of age - -Answer: 2
Explanation: Starting iron-fortified infant cereal at 4 to 6 months of age is recommended
for prevention of iron deficiency in children. Infants who are not breast-fed should get iron-
fortified formula. Cow's milk should not be introduced until 12 months of age. Vitamin C
should be started at 6 to 9 months of age and continued, because foods rich in vitamin C
improve iron absorption.
Page Ref: 593
-A child is diagnosed with sickle cell disease. The parents are unsure how their child
contracted the disease. Which explanation by the nurse is the most appropriate?
1. "Both the mother and the father have the sickle cell trait."
2. "The mother has the trait, but the father doesn't."
3. "The father has the trait, but the mother doesn't."
4. "The mother has sickle cell disease, but the father doesn't have the disease or the trait." -
-Answer: 1
,Explanation: 1. Sickle cell disease is an autosomal recessive disorder; both parents must
have the trait in order for a child to have the disease.
Page Ref: 594
-The charge nurse on a pediatric unit is making a room assignment for a school-age child
diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which room
assignment is most appropriate for this client?
1. Semiprivate room
2. Reverse-isolation room
3. Contact-isolation room
4. Private room - -Answer: 4
Explanation: Splenic sequestration can be life-threatening, and there is profound anemia.
The child does not need an isolation room but should not be placed in a room with any
child who may have an infectious illness. The private room is appropriate for this child.
Page Ref: 596
-The nurse is providing care for an adolescent client who is experiencing pain related to a
sickle cell crisis. Which medication does the nurse prepare to administer to this client?
1. Morphine sulfate
2. Meperidine
3. Acetaminophen
4. Ibuprofen - -Answer: 1
Explanation: The pain during a sickling crisis is severe, and morphine is needed for pain
control around the clock or by patient-controlled analgesia (PCA). Meperidine is not used
for pain control for clients with sickle cell pain crisis because it could cause seizures.
Acetaminophen or ibuprofen is used for mild pain and would not be effective for the severe
pain experienced by a child in sickle cell pain crisis.
Page Ref: 598
-The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle cell
disease. Which precipitating factors to a sickle cell crisis will the nurse include in the
explanation?
Select all that apply.
1. Fever
2. Dehydration
3. Regular exercise
4. Altitude
5. Increased fluid intake - -Answer: 1, 2, 4
,Explanation: Fever, dehydration, and altitude are precipitating factors contributing to a
sickle cell crisis. Regular exercise and increased fluid intake are recommended activities for
a child with sickle cell disease and will not contribute to a sickle cell crisis.
Page Ref: 598
-The nurse is administering packed RBCs to a child with sickle cell disease (SCD). The
nurse is monitoring for a transfusion reaction and knows it is most likely to occur during
which time frame?
1. Six hours after the transfusion is given
2. Within the first 20 minutes of administration of the transfusion
3. At the end of the administration of the transfusion
4. Never; children with SCD do not have reactions. - -Answer: 2
Explanation: Blood reactions can occur as soon as the blood transfusion begins or within
the first 20 minutes. The nurse should remain with the child for the first 20 minutes of the
transfusion.
Page Ref: 598
-A child who has beta-thalassemia is receiving numerous blood transfusions. The child is
also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will
help their child. Which rationale does the nurse use when responding to the parents?
1. It prevents blood transfusion reactions.
2. It stimulates RBC production.
3. It provides vitamin supplementation.
4. It prevents iron overload. - -Answer: 4
Explanation: Iron overload can be a side effect of a hypertransfusion therapy.
Deferoxamine (Desferal) is an iron-chelating drug, which binds excess iron so it can be
excreted by the kidneys. It does not prevent blood-transfusion reactions, stimulate RBC
production, or provide vitamin supplementation.
Page Ref: 602
-A child recently diagnosed with aplastic anemia is being prepared for discharge. When
planning support for the family, which service should the nurse plan to include in the
discharge plan?
1. Referrals to support groups and social services
2. Short-term support
3. Genetic counseling
4. Nutrition counseling - -Answer: 1
, Explanation: Families require support in dealing with a child who has a life-threatening
disease. They should be referred to support groups for counseling, if indicated, and to
social services. The support will be long term in nature. Aplastic anemia is not a genetically
transmitted disease. Nutrition counseling is not a priority and may or may not be needed
with aplastic anemia.
Page Ref: 603
-A school-age child with hemophilia falls on the playground and goes to the nurse's office
with superficial bleeding above the knee. Which action by the nurse is the most
appropriate?
1. Apply a warm, moist pack to the area.
2. Perform some passive range of motion to the affected leg.
3. Apply pressure to the area for at least 15 minutes.
4. Keep the affected extremity in a dependent position. - -Answer: 3
Explanation: If a hemophiliac child experiences a bleeding episode, superficial bleeding
should be controlled by applying pressure to the area for at least 15 minutes. Ice should be
applied, not heat. The extremity should be immobilized and elevated, so passive range of
motion and keeping the extremity in a dependent position would not be appropriate
interventions at this time.
Page Ref: 604
-A child diagnosed with hemophilia plans on participating in a bicycling club. Which
recommendation by the nurse is the most appropriate?
1. Consider a swim club instead of the bicycling club.
2. Wear kneepads, elbow pads, and a helmet while bicycling.
3. Participate only in the social activities of the club.
4. Not join the club. - -Answer: 2
Explanation: Children with hemophilia should be encouraged to participate in noncontact
sports activities. Bicycling is an excellent option and is recommended along with
swimming. The child should always use kneepads, elbow pads, and a helmet when
participating in a physical sport. Participating only in the social aspects of the club would
not encourage physical activity. Discouraging a child from joining a club would not foster
growth and development.
Page Ref: 604-605
-The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which
nursing intervention is a priority for this child?
1. Frequent ambulation
The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency anemia.
Which finding indicates that the infant is not tolerating activity?
1. Heart rate of 138
2. Increased alertness
3. Respiratory rate less than 40 with activity
4. Muscle weakness - -Answer: 4
Explanation: Iron deficiency anemia can result in less oxygen reaching the cells and tissues,
causing activity intolerance. An indication that a 9-month-old child is not tolerating activity
and that iron deficiency anemia is worsening would be the presence of muscle weakness
during activity. A heart rate of 138, increased alertness, and a respiratory rate of less than
40 with activity are all signs that iron deficiency anemia is resolving and activity tolerance
is improving.
Page Ref: 592
-Which action by the parents demonstrates an understanding of the nurse's teaching with
regard to prevention of iron-deficient anemia?
1. Feeding their infant with a formula that is not iron fortified
2. Starting iron-fortified infant cereal at 4 to 6 months of age
3. Introducing cow's milk at 6 months of age
4. Limiting vitamin C consumption after 1 year of age - -Answer: 2
Explanation: Starting iron-fortified infant cereal at 4 to 6 months of age is recommended
for prevention of iron deficiency in children. Infants who are not breast-fed should get iron-
fortified formula. Cow's milk should not be introduced until 12 months of age. Vitamin C
should be started at 6 to 9 months of age and continued, because foods rich in vitamin C
improve iron absorption.
Page Ref: 593
-A child is diagnosed with sickle cell disease. The parents are unsure how their child
contracted the disease. Which explanation by the nurse is the most appropriate?
1. "Both the mother and the father have the sickle cell trait."
2. "The mother has the trait, but the father doesn't."
3. "The father has the trait, but the mother doesn't."
4. "The mother has sickle cell disease, but the father doesn't have the disease or the trait." -
-Answer: 1
,Explanation: 1. Sickle cell disease is an autosomal recessive disorder; both parents must
have the trait in order for a child to have the disease.
Page Ref: 594
-The charge nurse on a pediatric unit is making a room assignment for a school-age child
diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which room
assignment is most appropriate for this client?
1. Semiprivate room
2. Reverse-isolation room
3. Contact-isolation room
4. Private room - -Answer: 4
Explanation: Splenic sequestration can be life-threatening, and there is profound anemia.
The child does not need an isolation room but should not be placed in a room with any
child who may have an infectious illness. The private room is appropriate for this child.
Page Ref: 596
-The nurse is providing care for an adolescent client who is experiencing pain related to a
sickle cell crisis. Which medication does the nurse prepare to administer to this client?
1. Morphine sulfate
2. Meperidine
3. Acetaminophen
4. Ibuprofen - -Answer: 1
Explanation: The pain during a sickling crisis is severe, and morphine is needed for pain
control around the clock or by patient-controlled analgesia (PCA). Meperidine is not used
for pain control for clients with sickle cell pain crisis because it could cause seizures.
Acetaminophen or ibuprofen is used for mild pain and would not be effective for the severe
pain experienced by a child in sickle cell pain crisis.
Page Ref: 598
-The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle cell
disease. Which precipitating factors to a sickle cell crisis will the nurse include in the
explanation?
Select all that apply.
1. Fever
2. Dehydration
3. Regular exercise
4. Altitude
5. Increased fluid intake - -Answer: 1, 2, 4
,Explanation: Fever, dehydration, and altitude are precipitating factors contributing to a
sickle cell crisis. Regular exercise and increased fluid intake are recommended activities for
a child with sickle cell disease and will not contribute to a sickle cell crisis.
Page Ref: 598
-The nurse is administering packed RBCs to a child with sickle cell disease (SCD). The
nurse is monitoring for a transfusion reaction and knows it is most likely to occur during
which time frame?
1. Six hours after the transfusion is given
2. Within the first 20 minutes of administration of the transfusion
3. At the end of the administration of the transfusion
4. Never; children with SCD do not have reactions. - -Answer: 2
Explanation: Blood reactions can occur as soon as the blood transfusion begins or within
the first 20 minutes. The nurse should remain with the child for the first 20 minutes of the
transfusion.
Page Ref: 598
-A child who has beta-thalassemia is receiving numerous blood transfusions. The child is
also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will
help their child. Which rationale does the nurse use when responding to the parents?
1. It prevents blood transfusion reactions.
2. It stimulates RBC production.
3. It provides vitamin supplementation.
4. It prevents iron overload. - -Answer: 4
Explanation: Iron overload can be a side effect of a hypertransfusion therapy.
Deferoxamine (Desferal) is an iron-chelating drug, which binds excess iron so it can be
excreted by the kidneys. It does not prevent blood-transfusion reactions, stimulate RBC
production, or provide vitamin supplementation.
Page Ref: 602
-A child recently diagnosed with aplastic anemia is being prepared for discharge. When
planning support for the family, which service should the nurse plan to include in the
discharge plan?
1. Referrals to support groups and social services
2. Short-term support
3. Genetic counseling
4. Nutrition counseling - -Answer: 1
, Explanation: Families require support in dealing with a child who has a life-threatening
disease. They should be referred to support groups for counseling, if indicated, and to
social services. The support will be long term in nature. Aplastic anemia is not a genetically
transmitted disease. Nutrition counseling is not a priority and may or may not be needed
with aplastic anemia.
Page Ref: 603
-A school-age child with hemophilia falls on the playground and goes to the nurse's office
with superficial bleeding above the knee. Which action by the nurse is the most
appropriate?
1. Apply a warm, moist pack to the area.
2. Perform some passive range of motion to the affected leg.
3. Apply pressure to the area for at least 15 minutes.
4. Keep the affected extremity in a dependent position. - -Answer: 3
Explanation: If a hemophiliac child experiences a bleeding episode, superficial bleeding
should be controlled by applying pressure to the area for at least 15 minutes. Ice should be
applied, not heat. The extremity should be immobilized and elevated, so passive range of
motion and keeping the extremity in a dependent position would not be appropriate
interventions at this time.
Page Ref: 604
-A child diagnosed with hemophilia plans on participating in a bicycling club. Which
recommendation by the nurse is the most appropriate?
1. Consider a swim club instead of the bicycling club.
2. Wear kneepads, elbow pads, and a helmet while bicycling.
3. Participate only in the social activities of the club.
4. Not join the club. - -Answer: 2
Explanation: Children with hemophilia should be encouraged to participate in noncontact
sports activities. Bicycling is an excellent option and is recommended along with
swimming. The child should always use kneepads, elbow pads, and a helmet when
participating in a physical sport. Participating only in the social aspects of the club would
not encourage physical activity. Discouraging a child from joining a club would not foster
growth and development.
Page Ref: 604-605
-The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which
nursing intervention is a priority for this child?
1. Frequent ambulation
